Intro to Critical Care - Block 4 Flashcards
What types of acute organ dysfunction fall under ICU?
- Shock
- Sepsis
- ADHF
- Acute tox
- Status epilepticus
- Stroke
- End organ damage from chronic dx
Who are closely monitoring the ICU?
- Trauma
- High risk surgeries (CABG, neurosurgical)
- High risk bleeding
What are the phases of crit illness?
- Rescue
- Optimization
- Stabilization
- De-escalation (step-down)
Route of med most common in ICU?
IV route:
1. Predicatable F
2. Fast onset
3. Rapid titratability
4. Wide therapeutic window
How is absorption affected in crit patients?
- Perfusion deficits
- Dysmotility
- Altered pH
- Loss in bowel integrity (perforation)
- Peripheral/gut edema
- Regional blood flow
Changes in Vd is affected by?
- FLuid shifts
- Tissue perfusion
- PPB
- Reduced tissue perfusion decreases distribution of hydrophilic medications
- Lipophilic (lipid-soluble) medications penetrate well into tissues independent of blood flow
What is shock liver?
Hypoxic hepatitis:
1. Acute cardiopulmonary failure
2. Transient increase in serum aspartate or alanine aminotransferase
3. Exclusion of other etiologies
When is augemented renal clearance used?
CrCl >120-160
How is distribution affected in crit patients?
- Largevolume resuscitation
- Capillary leak syndrome
- Ascites
- Mechanical ventilation
- Hypoalbuminemia
- ECMA
- Decreased a1 acid glycoprotein
How is metabolism affected in crit?
- Hepatic enzyme induction
- Augmented hepatic blood flow
- Hepatic enzyme inhibition
- Decreased hepatic blood flow
How is excretion affected by crit?
- Augmented renal clearance
- Extracorporeal removal
- AKI
What is MODS?
Potentially reversible physiologic derangement involving 2 or more organ systems not involved in disoder that resulted in ICU
What are you vital organs for survival?
Brain, kidney, heart, lung, liver
How do you interpret MOD score?
↑ MOD -> ↑ organ damage and mortality
MOD score of 0 is the best, 4 is the worst
How do you calculate R/P ratio?
(HR x right atrial pressure)/MAP